Use of Circumflex Scapular Vessels as a Recipient Pedicle for Autologous Breast Reconstruction: A Report of 40 Consecutive Cases

Abstract

The use of the circumflex scapular pedicle as a recipient vessel for breast reconstruction in a series of 40 consecutive cases in 37 patients is reported. There were 3 bilateral reconstructions and 34 unilateral reconstructions. Twenty-one cases were immediate reconstructions, and 19 cases were secondary reconstructions. The diameter of the artery varied from 1.5 mm to 3 mm and systematically matched with the diameter of the epigastric artery. The artery was a branch of the subscapular system in 82.5 percent of cases (33 of 40). In 17.5 percent of cases (7 of 40), the artery was a direct branch of the axillary artery. The length of available pedicle between the axillary vessel and the distal part where it can be divided (on its division between scapular and parascapular artery) was of 76 +/- 13 mm for the artery and 72 +/- 12 mm for the vein. The vein was unique in 77.5 percent of cases. The diameter was similar to the artery diameter when unique. There was a dual venous system in 21 of 40 cases (52.5 percent) but in 15 cases (37.5 percent), one of the two veins was dominant. In the seven cases for which the veins were dual and of equivalent diameter, the epigastric veins were also dual and allowed a second anastomosis. Clinically, the anastomosis was always possible on the artery. In one case of reconstruction after Halstedt mastectomy, no vein could be found, because all the veins had been ligated previously. One venous thrombosis (2.5 percent) and one arterial thrombosis were experienced. Both were treated by revised anastomoses and did not compromise late results. The circumflex scapular pedicle is a reliable and simple recipient site for breast reconstruction. It allows a unique site of dissection in immediate reconstruction and avoids division of the thoracodorsal pedicle. The technique is now used exclusively at this institution.

Time‐dependent factors in DIEP flap breast reconstruction

“…The choice is largely up to the reconstructive surgeon and usually based on comfort level and experience, flow characteristics, chest topography, and patient comorbidities. The recent trend in literature claimed the use of IMV as recipient vessels (Lantieri et al, ; Moran, Nava, Behnam, & Serletti, ; Serletti, Moran, Orlando, & Fox, ), even if some authors note unpredictable quality and inconsistency of the internal mammary veins diameter at the level of the fourth rib often necessitating vein grafts (Lorenzetti, Kuokkanen, von Smitten, & Asko‐Seljavaara, ). Time for vessels' dissection and exposure in immediate reconstruction represents an issue in favor of the axillary vessels.…”

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

“…Good volume [130] Reliable blood supply [130] Free TRAM flaps can create reconstructions that are as aesthetically pleasing as DIEP flaps [131] Greater abdominal wall morbidity than DIEP flaps resulting in hernia (2.6%) or abdominal bulge (3.8%), especially in obese patients Decreased abdominal wall strength [129,121] Common methods of breast reconstruction post-mastectomy Latissimus Dorsi flap Robust blood supply [130,131] Good salvage option for re-operations [130,131] A readily available option for almost all patients [131] Limited volume compared to DIEP and TRAM flaps …”

“…Commonly used recipient vessel with proven reliability [14,83,116,120,121]. Does not preclude future CABG.…”

“…Circumflex scapular artery Large arterial and venous diameters (1.5-3 mm) are favourable for microanastamosis to the DIEP pedicle [121].…”

Mise en place d’une activité de reconstruction microchirurgicale du sein par tissus autologues. Évolution sur 20ans et revue de 1138 cas

“…Si on peut conclure à une supériorité de l'artère et de la veine mammaire interne en reconstruction immédiate cela est plus difficile en reconstruction secondaire où on retrouve souvent une artère calcifiée et fragile avec des veines friables en particulier du côté gauche. Nous avions décrit le branchement sur le pédicule circonflexe scapulaire montrant qu'il était constant et fiable [7]. Le pédicule circonflexe scapulaire même s'il n'est plus notre premier choix reste un pédicule utilisé soit lorsque le pédicule mammaire interne n'est pas de bonne qualité mais aussi lorsqu'il y a une thrombose ceci permettant de refaire l'anastomose sur des vaisseaux donneurs de bonne qualité.…”